Rheumatism - infectious disease, in which there is a systemic failure of the connective tissue, most often occurs in children during adolescence. When this inflammation develops mainly in the cardiovascular system organs.
GENERAL
Symptoms of rheumatic fever was first described by the ancient Greek physician Hippocrates healer. In his medical treatise he mentioned fever and migratory joint pain. It was believed that this pathology is caused by a poisonous liquid, spreading through the blood vessels. Hence, the name "rheumatism," which in Greek means "fluidity". In a separate disease entities disease was highlighted in the XIX century, after the work Sokolsky and Buyo - eminent specialists in medical practice. They tied streptococcal infection in history with a further defeat of connective tissue elements in the cardiovascular system, joints and other organs.
In pediatric rheumatic fever is an actual problem, in spite of the continuous improvement of diagnosis and treatment. According to studies, the incidence of the disease varies from 0.3 to 18.6 cases per one thousand. school-age children. It depends on the level of socio-economic development of the region. Recently, rheumatism recorded less frequently in children, indicating a progressive efforts to the healthcare industry worldwide.
CAUSES
In the development of rheumatic fever plays a key role nasopharyngeal infection with certain strains of streptococcal bacteria. It is proved that the pathogen belongs to the group A.
At the end of the last century, toxic and immunological hypothesis of the pathogenesis of the disease has been formulated. World Health Organization experts have identified 2 main link in the formation of rheumatism.
Toxic and immunological hypothesis:
- Damage to the heart tissue waste products and toxic enzymes secreted by streptococci.
- Development of autoimmune inflammatory process due to antigenic similarity cardiomyocytes structure with certain strains of the pathogen. This proximity allows us not only to stay for a long time streptococci in the human body, but also makes the heart cells are a target for their own specific immune complexes.
children's rheumatism pathogenesis is not radically different from the above hypothesis.
In addition to streptococcal infection of the nasopharynx, in the development of rheumatic fever in children play an important role predisposing factors, which include:
- genetic predisposition;
- presence of chronic infection foci in the mouth or respiratory tract;
- defects in the immune system of the child;
- endocrine pathology.
CLASSIFICATION
Modern classification of disease was proposed by the creator of the national school of Rheumatology AI Nesterov. He shared the disease on four main criteria:
- degree of activity;
- current character;
- severe circulatory failure;
- the nature of organ damage.
Depending on the severity of each of the criteria for changing symptoms and treatment in children.
SYMPTOMS
Symptoms of rheumatic fever in children occur within 15-20 days after undergoing nasal infection. For the first attack of the disease is characterized by phasing the development of the clinical picture.
The patient raises the following complaints:
- increase in body temperature to 38-39 degrees;
- general weakness;
- insomnia;
- loss of appetite;
- headache and muscle pain.
At the same time as signs of intoxication symptoms of joint damage.
Characteristics of arthritis:
- Most often affects the large joints;
- Localization of pain varies;
- pain intensity is high, due to which the amount of active movements is greatly reduced;
- fast regression of symptomatology using anti-inflammatory drugs.
Such signs of rheumatic fever in children indicate that the acute phase of the disease is observed in 80% of cases. With a weak activity of the inflammatory process, arthritis symptoms may be absent.
heart damage
Children accompanied by various rheumatic heart disease, the most common of which is myocarditis. Most patients report a slight signs of disease, including:
- change in the general conditions;
- pale skin;
- disruptions of the heart;
- discomfort behind the breastbone.
At high activity autoimmune inflammatory process affects other organs and systems.
Extracardiac pathology:
- Damage to the nervous system manifested a decrease in attention, increased irritability, involuntary contraction of the muscles of the body.
- Involvement of the pleura accompanied by pain, increasing in height inspiratory apnea and the appearance of dry cough.
- Rheumatism with prevalence of dermatological symptoms in patients appears erythema, petechial rash, nodules.
- Pretty rare to diagnose abdominal syndrome - pain in the abdomen, disturbance of physiological functions, nausea and vomiting
DIAGNOSTICS
Diagnose rheumatic fever in children help specific criteria developed by experts of the World Health Organization. The presence of 2 large or 1 large and two small criteria for confirmed streptococcal infection history indicates a high risk of developing rheumatic fever in children.
Big criteria:
- heart failure;
- Multiple inflammatory process in the joints;
- pathologies of the nervous system;
- erythema;
- rheumatic nodules.
Minor criteria:
- fever;
- joint pain;
- increase in erythrocyte sedimentation rate;
- appearance ostrofazofyh proteins;
- changes in the electrocardiogram.
It is worth remembering that the rheumatism in children there are no specific symptoms, so early detection and treatment of rheumatic fever in children with these symptoms depends on the qualifications of the doctor. In addition to a number of basic research, the pediatrician may prescribe an additional method for the differential diagnosis:
- phonocardiography, allowing to define the features of a heart noise and determine its location;
- echocardiography - ultrasound of the structural elements of the cardiovascular system;
- antistreptococcal titer determination of immune complexes.
High efficiency for the early detection syndromic diagnosis of rheumatism has proposed Nesterov. It consists of 3 components:
- Anamnestic relationship with streptococcal infection.
- Clinical and immunologic syndrome - asthenic manifestations of the disease in conjunction with an increase in the titer of specific antibodies.
- Cardiovascular syndrome - instrumental confirmation of the defeat of the heart muscle, joints and internal organs.
TREATMENT
In the treatment of rheumatic fever in a child using an integrated approach. It is important to not only relieve the symptoms of the disease, but also to influence the cause - streptococcal flora. Therapy is required inpatient even suspected rheumatism.
General measures:
- bed rest for the duration of the acute phase of the disease with the gradual expansion of the activity;
- health food with increased potassium content;
- correct child leisure organization.
drug therapy
To combat the pathogenic microflora, reducing the activity of the autoimmune inflammation and reduce the symptoms of use:
- antibiotics penicillin;
- hormone therapy;
- nonsteroidal antiinflammatory drugs;
- multivitamin complexes;
- potassium preparations;
- immunostimulants.
Side effects of therapy:
- the development of ulcers in the digestive tract;
- gastric bleeding;
- disruption of the functioning of the endocrine glands.
In the treatment of children's feet symptoms of rheumatism using special orthopedic appliances, offloads the inflamed joints of the lower extremities.
COMPLICATIONS
The child Rheumatism may be complicated by the following states:
- The development of heart diseases. Most often affects the mitral and aortic valves. It is accompanied by a breach of hemodynamics, the development of hypertrophy of the heart and corresponding stagnation in small or large circulation.
- Heart failure, manifested a decrease in contractile ability of the heart, in violation of its rhythm.
- Pericarditis, developing as a result of involvement in the pathological process of the pericardium.
- Bacterial embolism small capillaries of the internal organs.
PREVENTION
Prevention of rheumatic fever in children is divided into two main areas:
- primary;
- secondary.
primary prevention
According to the recommendations of the World Health Organization, is aimed at primary prevention prevention of streptococcal infection and adequate therapy at the first symptoms of child rheumatism. In the latter case, use:
- antibacterials penicillins;
- anti-inflammatories;
- other etiotropic and symptomatic medication.
secondary prevention
It is used to prevent recurrent rheumatic fever. It is based on constant-year operation bitsillinovyh preparations. The duration depends on the activity of the inflammatory process, relapse rate, presence of complications, and can range from three to five years.
Non-pharmacological methods of prevention:
- a balanced diet, rich in vitamins;
- normalization of physical activity;
- sanitation of foci of chronic infections;
- spa treatment.
FORECAST FOR RECOVERY
The prognosis of rheumatoid arthritis in children depends on the severity of the cardiac lesions, because already after the first attack of the disease in six of the patients having heart diseases.
Factors that aggravate forecast:
- excessive or minimal activity of the inflammatory process;
- early appearance and rapid progression of circulatory insufficiency;
- frequent repeated attacks of the disease;
- cases of death from rheumatic close relatives.
In children with rheumatic heart exceptional role played by adequate therapy and preventive measures aimed at the prevention of complications. Clinical experience of health professionals show that a total volume of treatment in the first three days after the primary attack is avoided significant cardiac lesions.
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